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milk is, from an evolu- tionary perspective, the biological norm, the time-tested standard of care. The health benefits to the infant of breast- feeding have been amply documented; numerous studies strongly indicate signif- icantly decreased risks of infection, allergy, asthma, arthritis, diabetes, obesity, cardio- vascular disease, and various cancers in both childhood and adulthood. Among the more fundamental disadvantages of not being breastfed is a loss of immuno- logic protection afforded by maternal colostrum, a \u201cpre-milk\u201d fluid secreted only during the first days after delivery, as well as numerous other bioactive factors that help protect the infant through the first two years of life, when the immune and nervous systems are incompletely developed. Nevertheless, given the ten- dency for persistent organic pollutants
(POPs), pesticides, heavy metals, and other contaminants to accumulate in human milk, researchers and parents alike are asking whether the nursling\u2019s exposure to these pollutants might reduce or even override the health benefits.
Throughout primate evolution and pre- industrial human history, breastfeeding was the rule: the mother carried her baby and breastfed on demand. According to nutritional anthropologist Daniel W. Sellen in the 2007 edition of the Annual Review
2 years was typical in 75\u201383% of hunter\u2013gatherer societies, with the average age at weaning approximately 30 months. Moreover, copious data now support the hypothesis that humans evolved to begin consuming foods besides mother\u2019s milk at approximately 6 months of age (Sellen also notes humans are the only primates that wean their
infants before they can forage for themselves). This pattern was proba- bly the norm for 200,000 years of human evolution and some 7 mil- lion years of nonhuman primate evolution.
A radical change occurred in the late 1800s, with the widespread relo- cation of rural populations to urban areas resulting in lifestyle and socio- cultural changes that disrupted the normal breastfeeding pattern. In a historical overview published in the December 2003 issue of theAmeri-
University sociologist Jacqueline H. Wolf described how large numbers of women in all echelons of European and U.S. society, prompted by differ- ent socioeconomic and cultural fac- tors, began to supplement their own milk with cows\u2019 milk soon after giv- ing birth. Some avoided breastfeed- ing altogether, and those who did breastfeed increasingly weaned their babies before 3 months of age.
Then, in the early 1900s, U.S. public health officials began to report that \u201chand feeding\u201d infants with unhygienically processed cow\u2019s milk was spawning an epidemic of infant death and disease. In Chicago, for example, nearly 1 in 5 babies died before their first birthday, mainly from diarrhea, and for every breastfed baby that died there were 15 deaths from hand feeding. As part of a pub- lic health campaign to lower infant mortality, posters were mounted throughout U.S. cities urging mothers to breastfeed.
By the late 1920s, laws in most municipalities mandated that cow\u2019s milk be processed under sanitary conditions, and pasteurized milk was hailed as safe for young and old alike. Despite continued warnings by public health officials on the haz- ards of artificial feeding, efforts to
At the same time, more women began having their babies in hospitals rather than at home. Mothers and infants increasingly were separated as a matter of course after delivery, due to the rising use of anesthesia during labor, among other factors. Pro- longed separation after birth can make it more difficult to establish breastfeeding; a Japanese study published by Nakao et al. in the January 2008 International Breastfeeding
breastfeeding at 4 months compared with mothers who initiated breastfeeding more than 2 hours after birth.
Over the next few decades, the increas- ing availability of \u201cmilk substitutes\u201d meant that more working-class women could enter the workplace sooner or devote more time to personal pursuits. \u201cBy 1971, breastfeeding had reached an all-time low in the United States. Only 24% of mothers initiated breastfeeding\u2014that is, only 24% breastfed at least once before hospital dis- charge,\u201d wrote Wolf in the American Jour-
Today, the prevalence of initial breastfeeding among U.S. mothers is about 71%, according to a report in the 3 August 2007 Morbidity and
11\u201314% of infants are exclusively breastfed (i.e., consume nothing else, including water) in the first 6 months, as recommended by the American Academy of Pediatrics and the World Health Organization (WHO). Only 16% of U.S. infants are still breastfeeding at 1 year of age; probably far fewer go on to breastfeed for the 2 years recom- mended by the WHO.
Figures in the February 2005 issue of Public Health Nutrition point to wide variation across the few European countries for which breastfeeding data are available. Ini- tiation rates range from 63 to 99%, exclusive breastfeeding at 6 months ranges from 1 to 46%, and breast- feeding at 12 months ranges from 4 to 36%, with Nordic countries consistently showing the highest rates at each point.
Meanwhile, in many developing countries, the length of time babies are completely breastfed remains low. For example, in African coun- tries about one-quarter of mothers exclusively breastfeed for 6 months, according to WHO figures. Yet a study reported by Edmond et al. in the March 2006 issue ofP e d i a t r i c s found that 16% of all neonatal deaths in Ghana could be prevented if infants were breastfed from day one, 22% if breastfeeding started within the first hour after birth.
Maternal employment can be a major limiting factor in terms of breastfeeding duration. A study by Joan Y. Meek in the April 2001
found that only 10% of full-time working mothers provided any breast milk to their 6-month-olds, compared with almost 3 times that number of stay-at-home mothers; this pattern was consistent across all ethnic, educational, and age groups.
In the years since that study was pub- lished, numerous employers have established lactation rooms and breastfeeding-supportive workplace policies, and such efforts appear to be paying off. In the September\u2013October 2006 issue of Women\u2019s Health Issues, Ryan et al. reported that 26.1% of mothers stud- ied who worked full-time and 36.6% of
The mother supports the host defense of the
infant in two ways. One is via antibodies from
her blood that are actively transported over
the placenta to the infant\u2019s circulation during
fetal life and are ready for use from birth on.
The other is due to the numerous and complex
defense factors provided via the mother\u2019s milk,
available directly after delivery.
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